Provider Demographics
NPI:1326297011
Name:ST. GEORGE, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:ST. GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E 10TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7625
Mailing Address - Country:US
Mailing Address - Phone:917-553-7924
Mailing Address - Fax:
Practice Address - Street 1:219 E 10TH ST
Practice Address - Street 2:APT2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7625
Practice Address - Country:US
Practice Address - Phone:917-553-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245419207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine